The need for special interventions for multiple hospital admission patients.

Although a high proportion of Medicare hospital admissions and expenditures are accounted for by a small proportion of the elderly who experience chronic patterns of acute hospital use, little emphasis has been placed on reducing hospitalization among these high users. Five interventions that have succeeded in substantially reducing the number of hospital days among high users living at home are discussed in this article, as are several interventions that have reduced hospital use by nursing home residents. With the passage of the Medicare Catastrophic Coverage Act of 1988, research and demonstration activities for high users of hospital care will, for the first time, have a Federal focus.